可调角度针道模板辅助较徒手穿刺^(125)I粒子植入治疗肺恶性肿瘤的优势研究  

An investigation of the advantages of the adjustable angle stitch template compared with CT-guided^(125)I seeds free-hand implantation in the treatment of non-small cell lung carcinoma

作　　者：汪建[1] 郝亮 雷光焰 宋永春[4] 牛洪欣 Wang Jian;Hao Liang;Lei Guangyan;Song Yongchun;Niu Hongxin(Department of Minimally Invasive Intervention,the Third Affiliated Hospital of Shandong First Medical University(Affiliated Hospital of Shandong Academy of Medical Sciences),Jinan 250031,China;Medical Department,the First Affiliated Hospital of Shandong First Medical University(Shandong Provincial Qianfoshan Hospital),Jinan 250013,China;Department of Thoracic Surgery,Shaanxi Provincial Tumor Hospital,Xi′an 710061,China;Department of Oncology Surgery,the First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710061,China;Department of Minimally Invasive Intervention,Shandong Cancer Hospital and Institute,Shandong First Medical University and Shandong Academy of Medical Sciences,Jinan 250117,China)

机构地区：[1]山东第一医科大学第三附属医院(山东省医学科学院附属医院)微创介入科,济南250031 [2]山东第一医科大学第一附属医院(山东省千佛山医院)医务科,济南250013 [3]陕西省肿瘤医院胸部肿瘤外科,西安710061 [4]西安交通大学第一附属医院肿瘤外科,西安710061 [5]山东第一医科大学附属肿瘤医院(山东省肿瘤防治研究院)介入科,济南250117

出　　处：《中华内科杂志》2024年第5期480-485,共6页Chinese Journal of Internal Medicine

摘　　要：目的探讨可调角度针道模板辅助较徒手穿刺^(125)I粒子植入治疗肺恶性肿瘤的优势。方法随机对照研究。收集2018年5月至2023年1月山东省肿瘤医院、陕西省肿瘤医院、山东第一医科大学第三附属医院符合纳入标准并提供书面知情同意书的45例行放射性^(125)I粒子治疗的中晚期肺癌患者,根据是否应用可调角度针道模板辅助将患者分为模板组(n=21)和徒手组(n=24),其中模板组男16例、女5例,年龄(66±12)岁;徒手组男16例、女8例,年龄(62±8)岁。比较两组患者放射性^(125)I粒子植入治疗后剂量分布情况、粒子植入质量、术中CT扫描次数及粒子补种数量,评价可调角度针道模板辅助较徒手穿刺^(125)I粒子植入的优势。两组符合正态分布的计量资料以x¯±s表示,组间比较采用两独立样本t检验,组内比较采用配对t检验,偏态分布计量资料用M(Q 1,Q 3)表示,组间比较采用秩和检验;计数资料以[例(%)]表示,组间比较采用χ^(2)检验。以P<0.05为差异有统计学意义。结果模板组与徒手组在年龄(t=1.16,P=0.253)、肿瘤体积[(71±26)比(71±22)cm^(3),t=0.21,P=0.837]等基线水平比较,差异均无统计学意义(均P>0.05)。45例患者均顺利完成手术操作。模板组患者术前验证剂量参数90%靶区体积受照剂量(D90)、100%处方剂量所占体积(V100)、适形度指数(CI)、均匀性指数(HI)、靶区外体积指数(EI)与术后计划比较[(131.0±2.1)比(131.1±5.5)Gy,90.0%±0.4%比91.0%±2.8%,0.83±0.07比0.82±0.05,41%±11%比37%±13%,4.3%(2.9%,14.0%)比8.8%(5.2%,14.6%)],差异均无统计学意义(均P>0.05)。徒手组患者术前验证剂量参数D90与术后计划比较,差异无统计学意义[(131.4±2.9)比(128.6±8.6)Gy,P>0.05],术前V100、CI、HI、EI与术后计划比较[90.0%±0.5%比89.0%±3.0%,0.84±0.04比0.71±0.09,41%±9%比34%±10%,7.7%(4.9%,11.0%)比24.2%(14.3%,35.3%),差异均有统计学意义(均P<0.05)。模板组剂量植入质量评估[优85.7%Objective To investigate the advantages of adjustable angle needle path template compared with CT-guided^(125)I seeds free-hand implantation in the treatment of non-small cell lung carcinoma.Methods This randomized controlled trial involved the retrospective analysis of the clinical data of 45 patients with non-small cell lung carcinoma who underwent^(125)I seeds implantation at the Shandong Cancer Hospital,Shaanxi Provincial Tumor Hospital and The Third Affiliated Hospital of Shandong First Medical University from May 2018 to January 2023.Patients were divided into the template(n=21)and free-hand(n=24)groups,according to the modality used.The template group comprised 16 males and 5 females,aged(66±12)years,while the free-hand group comprised 16 males and 8 females,aged(62±8)years.The dose distribution,implant quality,intraoperative computed tomography(CT)scan times,and^(125)I seed reseeding numbers after implantation were compared between the two groups to evaluate the potential advantages of adjustable angle needle path template-assisted implantation over free-hand^(125)I implantation.Results Statistical comparison revealed no significant differences in age(t=1.16,P=0.253),tumor volume[(71±26)vs.(71±22)cm^(3),t=0.21,P=0.837),or any other baseline characteristics between the template and free-hand groups.Overall,45 patients successfully completed the operation.In the template group,the mean values of the D90(dose that was delivered to 90%of the target volume),V100(the target volume receiving 100%of the prescription dose),coverage index(CI),relative dose homogeneity index(HI),and external volume index(EI)pre-and post-implantation were(131.0±2.1)vs.(131.1±5.5)Gy,90.0%±0.4%vs.91.0%±2.8%,0.83±0.07 vs.0.82±0.05,41%±11%vs.37%±13%,and 4.3%(2.9%,14.0%)vs.8.8%(5.2%,14.6%),respectively.None of these parameters showed any significant difference(all P>0.05).In the free-hand group,the mean value of D90 pre-and post-implantation was(131.4±2.9)vs.(128.6±8.6)Gy,showing no significant difference(P>0.05),the mean va

关 键 词：碘放射性同位素 放射治疗剂量 非小细胞肺癌 近距离放射疗法 

分 类 号：R73[医药卫生—肿瘤]